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Blair C, Leonard R, Linden M, Teggart T, Mooney S. Allied health professional support for children and young adults living in and leaving care: A systematic scoping review. Child Care Health Dev 2024; 50:e13140. [PMID: 37300280 DOI: 10.1111/cch.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/06/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Children and young people living in and leaving care are known to have experienced significant childhood adversity and trauma resulting in potentially deleterious impact on their health and well-being across the life course. Studies point to the complex needs of this population who may benefit from allied health professional (AHP)-related support with limited studies located. This review sought to address this gap by systematically scoping empirical literature focused on the provision of AHP support to this cohort of children and young adults to assist an understanding of the service needs for this vulnerable population. METHODS This scoping review followed Arskey and O'Malley's five steps framework (2005) to identify and review relevant literature. A focus on identifying the evidence, challenges and gaps in research relating to AHP support for children and young people living in and leaving care was initially agreed, followed by a systematic search using a combination of three key concepts to identify relevant studies in five AHP disciplinary areas to identify best evidence in the past decade (2011-2021). Study inclusion criteria were based on empirical studies of children and young people living in care (0-17 years) and leaving care (18-25 years). A data extraction table was formulated as a means of charting the data, aligned with the scope and objectives of this review. Finally, data were subsequently collated, synthesised and reported based on key thematic areas emerging from included studies regarding AHP support to children and young people living in and leaving care. RESULTS A total of 13 studies met the review inclusion criteria. Included studies reported specifically on speech and language therapist (SLT; n = 5), occupational therapist (OT; n = 3) and arts-based therapies (n = 5). No studies were identified with regard to the use of physiotherapy and dietetics with this population. Results indicated that children and young people living in and leaving care have high rates of speech, language, communication and sensory needs. More rigorous screening, assessment and early intervention were identified as essential for this vulnerable group. Increased multidisciplinary collaboration and OT support for young adults in preparation for transition to independent living was identified as an urgent requirement. Included studies indicate promising results in relation to access to arts-based therapies with particular reference to identity formation for children and young people living in and leaving care. CONCLUSIONS Although evidence of effectiveness remains limited, AHP service provision (specifically speech and language therapy, occupational therapy and arts-based therapies) has the potential to contribute positively to addressing the complex and interacting needs of this vulnerable population. As a result, it is recommended that AHP service provision is integrated into the collaborative, multidisciplinary care available to children living in and leaving care. More extensive, higher quality research related to the benefits of AHP provision for this population of children and young people is essential to provide a more robust evidence base across the various professional disciplines that constitute allied health provision.
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Affiliation(s)
- Carolyn Blair
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Rachel Leonard
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | - Suzanne Mooney
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
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Blythe S, Elcombe E, Peters K, Burns E, Gribble K. Australian foster carers' views of supporting maternal breastfeeding and attachment in out-of-home care. CHILD ABUSE & NEGLECT 2022; 130:105360. [PMID: 34688491 DOI: 10.1016/j.chiabu.2021.105360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/03/2021] [Accepted: 10/04/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Breastfeeding supports infant health, growth and development, and promotes maternal attachment and sensitive caregiving. Maternal separation due to child protection concerns can result in termination of breastfeeding with associated adverse outcomes. How to preserve breastfeeding when infants are placed in out-of-home care is an issue of concern. OBJECTIVE To consider the views of foster carers towards provision of breastmilk and breastfeeding for infants in their care. PARTICIPANTS AND SETTING Foster carers (including kinship carers), in Australia, who had cared for at least one infant in the years 2013-2018 completed an online survey. METHODS Foster carer's views were collected via an online survey and subjected to content analysis. RESULTS Respondents (n = 184) expressed mixed views about; mothers breastfeeding during contact visits, increased frequency of contact visits for breastfeeding; and the provision of expressed breastmilk to infants in their care. Concerns were raised about the safety of breastmilk from mothers abusing substances and the value of breastfeeding if reunification was not possible. Because of these concerns, some carers discarded expressed breastmilk and resisted frequent contact. Conversely, breastfeeding was also viewed positively as a way for mothers to maintain attachment with their infants, where reunification of the mother-infant dyad was the goal. CONCLUSIONS This study highlights foster carers' view of breastfeeding as a facilitator of attachment between mothers and their infants. While fosters carers were largely supportive of breastfeeding as a way to improve infant health and facilitate mother-infant attachment, they held concerns regarding the safety of breastmilk supplied to them.
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Affiliation(s)
- Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Australia; Translational Research and Social Innovation Group, Ingham Institute, Australia.
| | - Emma Elcombe
- School of Nursing and Midwifery, Western Sydney University, Australia; Translational Research and Social Innovation Group, Ingham Institute, Australia
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Australia
| | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Australia
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Australia
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Liu Y, Su Y, Yin Y. Parental preference for boys in childhood and the health of the elderly: Evidence from China. Soc Sci Med 2022; 302:114986. [PMID: 35487011 DOI: 10.1016/j.socscimed.2022.114986] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study analyzed the relationship between parents' son preference in a person's childhood and their health when they become older, and tested whether childhood educational opportunities, health level, and care resources play mediating roles in this relationship. BACKGROUND China has entered a stage of aging population. The health of the elderly determines whether the government can successfully cope with the challenges brought about by the aging of the population. Chinese people are deeply influenced by Confucianism. The concept of "son preference" is related to residents' parenting strategies. Then, if one's parents exhibit a son preference in their childhood, will it affect one's health in old age? METHOD Based on the data of China Health and Retirement Longitudinal Study collected in 2014, this paper uses the least square method to analyze the impact of parents' preference in childhood for boys on the health of the elderly, and uses Karlson-Holm-Breen (KHB) to analyze the mediating effects of childhood educational opportunities, health level and care resources. RESULTS This study found that parents' preference for boys had a positive impact on the health of male children when they became elderly but had a negative impact on the health of female children when they became elderly. Childhood educational opportunities, health level, and care resources mediated this relationship. CONCLUSION It is necessary to analyze the impact of parents' preference for sons in one's childhood on the health of elderly, and intervene the adverse factors affecting the health, to improve the health level and quality of life of the elderly.
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Affiliation(s)
- Yiwei Liu
- School of Government, Central University of Finance and Economics. Address: 39 South College Road, Haidian District, Beijing, 100081, China.
| | - Yuting Su
- School of Government, Central University of Finance and Economics. Address: 39 South College Road, Haidian District, Beijing, 100081, China.
| | - Yuru Yin
- College of Literature and Law, Henan Agricultural University. Address: 15 Longzihu University Park, Zhengdong New District, Zhengzhou, Henan, China.
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Kaasinen M, Salokekkilä P, Häggman-Laitila A. Experiences of Finnish care leavers of their involvement in the aftercare services for child welfare clients. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e95-e104. [PMID: 33970519 DOI: 10.1111/hsc.13416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 04/01/2021] [Accepted: 04/13/2021] [Indexed: 06/12/2023]
Abstract
Children and young people placed in out-of-home care form a vulnerable group. Their involvement in decision making of their future is undermined by the lack of a safe 'adult security net' and the brevity of the period in which they are supposed to gain independence. Although there are some studies showing that the opportunity to affect the decision making is insufficient, there are no studies about how the involvement might actually be developed. This study describes young people's experiences of their involvement and the developmental needs for it in aftercare services for child welfare clients. The design was that of a qualitative explorative study. In total, 16 care leavers participated in the study. Data were collected by thematic interviews in autumn 2016 and analysed by qualitative content analysis. Good value-based collaboration with the staff and the possibility of mental, concrete and social support enhanced the young people's active involvement in their lives. The topics the interviewees wanted to see developed included the core values in the aftercare services, the comprehensiveness of the support and a future-oriented approach. Collaborative relationships should, it emerged, be based on individuality, equality, fairness, trust, a non-judgmental attitude, flexibility and safety and a general approach valuing, respecting, listening to and empowering the young person. Support should be provided with a comprehensive approach and in a multiprofessional and coordinated manner. The transition period to an independent life should be extended and carefully prepared, with an option for the continuity of the collaboration with the employees if needed.
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Affiliation(s)
- Minna Kaasinen
- Psykiatrian Poliklinikka, Kanta-Hämeen Keskussairaala, Hämeenlinna, Finland
| | - Pirkko Salokekkilä
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
| | - Arja Häggman-Laitila
- Department of Social Services and Health Care, City of Helsinki, Helsinki, Finland
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Hickey L, Galvin K, Parolini A, Nguyen B, Lokmic-Tomkins Z, Toovey R, Skeat J, Wise S. The engagement of children in out-of-home care with nursing and allied health professionals: A scoping review. Child Care Health Dev 2021; 47:758-770. [PMID: 34250634 DOI: 10.1111/cch.12893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 02/04/2021] [Accepted: 07/02/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Children living in out-of-home care (OOHC) have significant unmet health care needs and use more tertiary and specialist health care services compared with children from similar social and economic backgrounds. Allied health professionals and nurses have a central role in health care; however, very little is known about the engagement of children in OOHC with nursing and allied health professionals. This scoping review addresses this knowledge gap. METHODS A scoping review methodology framework was used to search for relevant articles published between January 1970 and November 2019, identified using three databases: MEDLINE, CINAHL and ProQuest. Selection of studies was based on empirical research about the health of children in OOHC and their engagement with nursing or allied health services. A total of 37 relevant articles met the eligibility criteria for inclusion in this review. RESULTS Findings could be summarized under five broad themes: (1) nursing and allied health professionals engaging with children in OOHC to support their health and development, (2) opportunities and challenges for nursing and allied health professionals to engage children in OOHC in healthcare, (3) identification and complexity of healthcare needs, (4) access to healthcare services and (5) coordination of healthcare. CONCLUSIONS Children in OOHC have multiple healthcare needs that require monitoring and treatment by allied health professionals and the health and development of these children is best supported through comprehensive health screening on entry into OOHC, and community-based, multidisciplinary healthcare while children are living in OOHC. While nurses in hospitals and community settings were found to play a role in health assessment and care coordination targeted at children in OOHC, the literature was silent on the role of allied health professionals in this healthcare approach.
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Affiliation(s)
- Lyndal Hickey
- Department of Social Work, The University of Melbourne, Carlton, Victoria, Australia
| | - Karyn Galvin
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Arno Parolini
- Department of Social Work, The University of Melbourne, Carlton, Victoria, Australia
| | - Bao Nguyen
- Department of Optometry and Vision Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Rachel Toovey
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Jemma Skeat
- Department of Audiology and Speech Pathology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sarah Wise
- Department of Social Work, The University of Melbourne, Carlton, Victoria, Australia
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Nygren US, Tindberg Y, Eriksson L, Eriksson H, Sandberg H, Nordgren L. Team-based visits within Swedish child healthcare services: a national cross-sectional study. J Interprof Care 2021:1-18. [PMID: 34376097 DOI: 10.1080/13561820.2021.1902960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 01/27/2021] [Accepted: 03/10/2021] [Indexed: 10/20/2022]
Abstract
Complex healthcare needs can be met through effective interprofessional collaboration. Since 2014, Swedish Child Healthcare Services (CHS) include universal team-based visits with a nurse and a physician who perform such visits at the age of 4 weeks, 6 months, 12 months, and 2.5 to 3 years, as well as targeted team-based visits to address additional needs. The aim of this study was to describe the prevalence of team-based visits in the Swedish CHS and possible associations between team-based visits and contextual factors that may affect its implementation. A national cross-sectional survey was conducted using a web-based questionnaire distributed to all reachable nurses, physicians, and psychologists (n =3,552) engaged in the CHS. Data were analyzed using descriptive statistics and binary and multivariate logistic regressions. The response rate was 32%. Team-based visits were reported by 82% of the respondents. For nurses and physicians, the most frequent indication was specific ages, while for psychologists it was to provide parental support. Respondents working at Family Centers were more likely to perform team-based visits in general, at 2.5 to 3 years and in case of additional needs, compared to respondents working at Child Health Centers (CHC) and other workplaces. In conclusion, team-based visits are well implemented, but the pattern differs depending on the contextual factors. Targeted team-based visits and team-based visits at the age of 2.5 to 3 years are most unequally implemented.
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Affiliation(s)
- Ulrika Svea Nygren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Ylva Tindberg
- Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Leif Eriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Eriksson
- Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Håkan Sandberg
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Center for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
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Marcellus L, MacKinnon K, Gordon C, Shaw L. Interventions and programs that support the health and development of infants with prenatal substance exposure in foster care: a scoping review. JBI Evid Synth 2021; 19:1844-1886. [PMID: 33993147 DOI: 10.11124/jbies-20-00071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review was to describe the characteristics of interventions and programs that support the health and development of infants in foster care who have prenatal substance exposure, their foster care providers, and birth families. INTRODUCTION Infants in foster care may have experienced prenatal substance exposure, neglect, and maltreatment, as well as disruptions in their relationships with primary caregivers. Despite multiple vulnerabilities, they also have great capacity for overcoming early adversities. Enhanced foster care has been identified as a key influence on the positive development of infants in the child welfare system. INCLUSION CRITERIA This scoping review considered publications that described interventions and programs designed to support foster care providers who care for infants less than 12 months of age with prenatal substance exposure. This review included research studies and gray literature. This scoping review focused on sources that described caregiving interventions and elements of programs that took place within the context of family or home-based foster care. METHODS A three-step search strategy was used to identify publications in the English language from January 2000 to December 2019. A literature search was conducted using MEDLINE, Academic Search Premier, PsycINFO, and CINAHL databases. Titles and abstracts were initially screened to assess if publications met the inclusion criteria, followed by full-text review. Publications that met the inclusion criteria were assessed by two independent reviewers using a data extraction tool developed for this review. Findings were thematically analyzed on the basis of similarity in focus and descriptively presented with tables and figures to support the findings. RESULTS Eighty-one publications were included, including 48 research papers and 33 gray literature sources. Thematic analysis of the focus of each publication resulted in identification of four core themes: i) mental health promotion for infants in care; ii) child welfare program elements; iii) identification of infants and families at risk of requiring foster care; and iv) outcomes for infants in care and their families. The interventions and programs identified during this scoping review were primarily focused on supporting social-emotional development. With the significant focus on infant mental health, supporting birth parents to stay attached to their infants was a key focus of the majority of publications. The concept of being able to proactively identify risk factors that were associated with infants requiring foster care emerged in relation to how family preservation could be supported. Strategies identified as contributing to the development of successful interventions and programs included having foster care providers participate as collaborators in designing services, designing services that are adaptable to a range of contexts, involving community partners outside child welfare, and having developmentally appropriate programs. CONCLUSIONS Infants represent a significant proportion of children in foster care. A developmental perspective is needed for child welfare service planning to address their unique needs. Intervention during the early years holds significant potential for promoting positive developmental pathways and family preservation.
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Affiliation(s)
- Lenora Marcellus
- The University of Victoria (UVic) Centre for Evidence-Informed Nursing and HealthCare (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
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Blythe S, Peters K, Elcombe E, Burns E, Gribble K. Australian Foster Carers' Views and Concerns Regarding Maternal Drug Use and the Safety of Breastmilk. CHILDREN-BASEL 2021; 8:children8040284. [PMID: 33916975 PMCID: PMC8067616 DOI: 10.3390/children8040284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 12/27/2022]
Abstract
Parental substance misuse and mental health issues are major factors associated with infant placement into out-of-home care. Such placements may result in disruption and/or cessation of breastfeeding. Provision of breastmilk to infants in out-of-home care (OOHC) is desirable in terms of infant health and development, and also in supporting maternal caregiving. However, little is known about how breastfeeding is supported for infants in out-of-home care. This study used an online survey to explore the facilitation of breastfeeding in the context of OOHC and foster carers' management of expressed breastmilk (EBM). Foster carers were generally open to the idea of maternal breastfeeding and infants in their care receiving EBM from their mothers. However, the majority of respondents expressed concern regarding the safety of EBM for infant consumption due to the possibility of harmful substances in the milk. Concerns regarding the safety of handling EBM were also prevalent. These concerns caused foster carers to discard EBM. Findings suggest foster carers' may lack knowledge related to maternal substance use and breastmilk. Better integration between health care and social service systems, where the voices of mothers, foster carers and child protection workers are heard, is necessary to develop solutions enabling infants living in OOHC access to their mother's breastmilk.
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Affiliation(s)
- Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Penrith 2763, Australia; (K.P.); (E.E.); (E.B.); (K.G.)
- Translational Research and Social Innovation (TReSI) Group, Ingham Institute of Applied Medical Research, Liverpool 2170, Australia
- Correspondence:
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith 2763, Australia; (K.P.); (E.E.); (E.B.); (K.G.)
| | - Emma Elcombe
- School of Nursing and Midwifery, Western Sydney University, Penrith 2763, Australia; (K.P.); (E.E.); (E.B.); (K.G.)
- Translational Research and Social Innovation (TReSI) Group, Ingham Institute of Applied Medical Research, Liverpool 2170, Australia
| | - Elaine Burns
- School of Nursing and Midwifery, Western Sydney University, Penrith 2763, Australia; (K.P.); (E.E.); (E.B.); (K.G.)
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Penrith 2763, Australia; (K.P.); (E.E.); (E.B.); (K.G.)
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Affiliation(s)
| | - Rebecca Mannel
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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10
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Mensah T, Hjern A, Håkanson K, Johansson P, Jonsson AK, Mattsson T, Tranæus S, Vinnerljung B, Östlund P, Klingberg G. Organisational models of health services for children and adolescents in out-of-home care: Health technology assessment. Acta Paediatr 2020; 109:250-257. [PMID: 31483896 PMCID: PMC7003841 DOI: 10.1111/apa.15002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/13/2019] [Accepted: 09/03/2019] [Indexed: 01/08/2023]
Abstract
AIM Decades of research confirm that children and adolescents in out-of-home care (foster family, residential care) have much greater health care needs than their peers. A systematic literature review was conducted to evaluate organisational health care models for this vulnerable group. METHODS A systematic literature search was undertaken of the following databases: Academic Search Elite, CENTRAL, Cochrane Database of Systematic Reviews, Cinahl, DARE, ERIC, HTA, PsycInfo, Psychology and Behavioural Sciences Collection, PubMed, SocIndex. Randomised and non-randomised controlled trials were to be included. Two pairs of reviewers independently assessed abstracts of the identified published papers. Abstracts meeting the inclusion criteria were ordered in full text. Each article was reviewed independently, by pairs of reviewers. A joint assessment was made based on the inclusion criteria and relevance. Cases of disagreement were resolved by consensus discussion. RESULTS No study with low or medium risk of bias was identified. CONCLUSION In the absence of studies of acceptable quality, it is not possible to assess the impact of organisational models intended to ensure adequate health and dental care for children and adolescents in out-of-home care. Therefore, well-designed follow-up studies should be conducted following the implementation of such models.
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Affiliation(s)
- Tita Mensah
- Faculty of OdontologyMalmö UniversityMalmöSweden
- The Clinic of Paediatric DentistryKarlstadSweden
| | - Anders Hjern
- Clinical EpidemiologyDepartment of MedicineKarolinska InstitutetStockholmSweden
- Centre for Health Equity Studies (CHESS)StockholmSweden
| | - Kickan Håkanson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Pia Johansson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
- Public Health & EconomicsHuddingeSweden
| | - Ann Kristine Jonsson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
| | - Titti Mattsson
- Faculty of LawHealth Law Research CentreLund UniversityLundSweden
| | - Sofia Tranæus
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
- Health Technology Assessment–Odontology (HTA‐O)Faculty of OdontologyMalmö UniversityMalmöSweden
- Department of Dental MedicineKarolinska InstitutetStockholmSweden
| | - Bo Vinnerljung
- Department of Social WorkStockholm UniversityStockholmSweden
| | - Pernilla Östlund
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU)StockholmSweden
- Health Technology Assessment–Odontology (HTA‐O)Faculty of OdontologyMalmö UniversityMalmöSweden
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Hermann JS, Featherstone RM, Russell ML, MacDonald SE. Immunization Coverage of Children in Care of the Child Welfare System in High-Income Countries: A Systematic Review. Am J Prev Med 2019; 56:e55-e63. [PMID: 30522895 DOI: 10.1016/j.amepre.2018.07.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/20/2018] [Accepted: 07/20/2018] [Indexed: 12/01/2022]
Abstract
CONTEXT Children in care of the child welfare system tend to underutilize preventive health services compared with other children. The purpose of this systematic review was to assess current knowledge regarding immunization coverage levels for children in the child welfare system and to determine barriers and supports to them utilizing immunization services. EVIDENCE ACQUISITION Articles published in Medline, Embase, Cochrane Library, CINAHL, SocINDEX, and ERIC from January 1, 2000 to October 13, 2017 were searched. Thesis and conference databases and relevant websites were also examined. Studies were included if written in English, from high-income countries, and addressed immunizations for children in the child welfare system. Independent dual screening, extraction, and quality appraisal were conducted between October 2016 and December 2017, followed by narrative synthesis. EVIDENCE SYNTHESIS Of 2,906 records identified, 33 met inclusion criteria: 21 studied coverage, two studied barriers/supports, and ten studied both. Nineteen studies were moderate or high quality and thus included in the narrative synthesis; 15 studied coverage, one studied barriers/supports, and three studied both. Most studies found lower coverage among children in child welfare. The few studies that explicitly studied barriers/supports to immunization identified that a collaborative and coordinated approach between health and social services was key to service delivery to this population. CONCLUSIONS This review highlights that children in care of the child welfare system are at risk of poor immunization coverage. There is a need for high-quality studies on this issue, with a focus on assessing supports/barriers to immunization in this population.
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Affiliation(s)
| | - Robin M Featherstone
- Alberta Research Centre for Health Evidence, University of Alberta, Knowledge Translation Platform, Alberta SPOR SUPPORT Unit, Edmonton, Alberta, Canada
| | - Margaret L Russell
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Hermann JS, Simmonds KA, Bell CA, Rafferty E, MacDonald SE. Vaccine coverage of children in care of the child welfare system. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2019; 110:44-51. [PMID: 30284125 PMCID: PMC6964484 DOI: 10.17269/s41997-018-0135-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/07/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess vaccine coverage for a cohort of children who have been in the care of the child welfare system compared to children in the general population. METHODS This retrospective cohort study used population-based administrative health data for a 2008 birth cohort of children from Alberta, Canada. We assessed coverage at ages 2 (n = 44,206) and 7 (n = 42,241) for three vaccines with different administration schedules for children in care (at any period before the age of assessment) and those who had never been in care, comparing them using risk differences and relative risks (RRs). We similarly assessed coverage for children not in care who shared characteristics of children in care. RESULTS At age two, vaccination coverage for children in care ranged from 54.3% to 81.4%, depending on vaccine. In comparison, coverage for those not in care ranged from 74.2% to 87.4%. At age seven, coverage for children in care ranged from 53.1% to 65.3%, compared to 76.6% to 83.4% for those not in care. For all vaccines at both ages, the risk for being under-vaccinated was higher for children in care (e.g., diphtheria, pertussis, tetanus, polio, Haemophilus influenzae type b at age 7: RR 2.01, 95% confidence interval [CI] (1.74-2.32). Even for children not in care who had characteristics similar to children in care, we found children in care had lower coverage. CONCLUSION Children in care have consistently lower vaccine coverage than children not in care. Policies and practices should promote optimal access to vaccination for these children.
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Affiliation(s)
- Jennifer S Hermann
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | | | - Christopher A Bell
- Analytics and Performance Reporting Branch, Alberta Health, Edmonton, Canada
| | - Ellen Rafferty
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
- School of Public Health, University of Alberta, Edmonton, Canada.
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Evicted children and subsequent placement in out-of-home care: A cohort study. PLoS One 2018; 13:e0195295. [PMID: 29668737 PMCID: PMC5905888 DOI: 10.1371/journal.pone.0195295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/20/2018] [Indexed: 11/21/2022] Open
Abstract
Background Evictions may have serious consequences for individuals’ health and wellbeing. Even though an eviction may be experienced as a significant crisis for the family, there is little previous knowledge on consequences for evicted children. This study represents the first attempt to examine to what extent children from evicted households were separated from their parents and placed in out-of-home care (foster family or residential care) using population-based data, net of observed confounding factors related to the socioeconomic and psychosocial circumstances of their parents. Methods This study takes advantage of information from a Swedish national database, consisting of about 8 000 evicted individuals and a random sample of 770 000 individuals from the national population, linked to individual-level, longitudinal data from Swedish national registers. Our analytical sample consists of information for more than 250 000 children born in 1995–2008, including 2 224 children from evicted households. We used binary logistic regression based on the Karlson/Holm/Breen method to account for observed imbalances at baseline between evicted and non-evicted children. Results Compared to non-evicted children, the crude odds ratio for placement in out-of-home care in evicted children was 12.10 (95% CI 8.54–17.14). Net of observed confounding factors related to the socioeconomic and psychosocial circumstances of the parents, evicted children had a twofold elevated risk of being placed in out-of-home care (odds ratio 2.26, 95% CI 1.55–3.27). Crude OR for evicted children in comparison with children under threat of eviction (eviction not formally executed) was 1.71 (95% CI 1.17–2.49) and adjusted OR 1.58 (95% CI 1.06–2.35). Conclusion Children who experience eviction constitute a disadvantaged group and are at significant risk of being separated from their parents and placed in out-of-home care. These results demonstrate the importance of providing support for these children and their parents. Strategies to prevent households with children from being evicted seem to be an important and viable intervention path.
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14
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Randsalu LS, Laurell L. Children in out-of-home care are at high risk of somatic, dental and mental ill health. Acta Paediatr 2018; 107:301-306. [PMID: 28986993 DOI: 10.1111/apa.14108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 08/09/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022]
Abstract
AIM The Swedish Social Board has implemented a support strategy to guide out-of-home care for children, which translates as children's needs in focus (CNIF) and includes a systematic health assessment. It was fully introduced into the Skåne province in 2012 and our study covered the first four years of the CNIF health assessments, from 2012 to 2015. METHODS We studied children aged 0-17 years in out-of-home care who had been referred by social workers for a CNIF health assessment, using their medical records to investigate both their health and the value of the health assessments. RESULT From 2012 to 2015, only 409 (6%) of the 11 413 children in out-of-home care were referred for health assessments. Their health issues included depression and anxiety (29%), poor dental health (30%), seeking medical care for traumatic injuries (36%), previous contact with child psychiatry services (38%) and missed medical appointments (36%), dental appointments (36%) and child health programme appointments (39%). In addition, 10% of the girls and 9% of the boys were obese. CONCLUSION This study found high levels of wide-ranging health issues. Despite national Swedish guidelines and policies, only 6% of the children in out-of-home care were referred by social workers for a CNIF health assessment.
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Affiliation(s)
| | - L Laurell
- Department of Paediatrics; Clinical Sciences; Lund University; Lund Sweden
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15
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Marcellus L, Shaw L, MacKinnon K, Gordon C. Interventions and programs that support the health and development of infants with prenatal alcohol and/or drug exposure in foster care: a scoping review protocol. ACTA ACUST UNITED AC 2017; 15:2848-2855. [DOI: 10.11124/jbisrir-2017-003371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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16
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Engh L, Janson S, Svensson B, Bornehag CG, Eriksson UB. Swedish population-based study of pupils showed that foster children faced increased risks for ill health, negative lifestyles and school failure. Acta Paediatr 2017; 106:1635-1641. [PMID: 28664570 DOI: 10.1111/apa.13966] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 01/31/2017] [Accepted: 06/26/2017] [Indexed: 11/30/2022]
Abstract
AIM This population-based study explored whether foster children faced a higher risk of health problems than children of the same age who were not in foster care. METHODS Data for 13 739 pupils aged 10, 13 and 16 years were obtained from the Pupil Health Database in the county of Värmland, Sweden, for the school years 2012/2013 and 2013/2014. These included data on school performance, health, lifestyle and social relationships, based on children's interviews with school nurses. RESULTS Of all the pupils, 171 (1.2%) were in foster care. Children in foster care were generally unhealthier than other children. Both girls and boys were at higher risk of chronic health problems, daily smoking, use of drugs and school failure. When the girls in foster care were compared to other girls, we found that they faced a higher risk of psychological and psychosomatic symptoms. This difference was not found for boys. Foster children were also more likely to express a more negative view on life. CONCLUSION We confirmed earlier studies that children in foster care tended to have inferior health and well-being than other children. These findings emphasise that health, risky behaviour and school performance should be considered together when assessing foster children.
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Affiliation(s)
- Lisbet Engh
- Division of Public Health Sciences; Karlstad University; Karlstad Sweden
| | - Staffan Janson
- Division of Public Health Sciences; Karlstad University; Karlstad Sweden
| | - Birgitta Svensson
- Center for Criminological And PsychoSocial Research; School of Law; Psychology and Social Work; Örebro University; Örebro Sweden
| | - Carl-Gustaf Bornehag
- Division of Public Health Sciences; Karlstad University; Karlstad Sweden
- Icahn School of Medicine at Mount Sinai; New York City NY USA
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17
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Köhler M, Rosvall M, Emmelin M. "All is well": professionals' documentation of social determinants of health in Swedish Child Health Services health records concerning maltreated children - a mixed method approach. BMC Pediatr 2016; 16:127. [PMID: 27526796 PMCID: PMC4986172 DOI: 10.1186/s12887-016-0646-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 07/15/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Knowledge about social determinants of health has influenced global health strategies, including early childhood interventions. Some psychosocial circumstances - such as poverty, parental mental health problems, abuse and partner violence - increase the risk of child maltreatment and neglect. Healthcare professionals' awareness of psychosocial issues is of special interest, since they both have the possibility and the obligation to identify vulnerable children. METHODS Child Health Services health records of 100 children in Malmö, Sweden, who had been placed in, or were to be placed in family foster care, were compared with health records of a matched comparison group of 100 children who were not placed in care. A mixed-method approach integrating quantitative and qualitative analysis was applied. RESULTS The documentation about the foster care group was more voluminous than for the comparison group. The content was problem-oriented and dominated by severe parental health and social problems, while the child's own experiences were neglected. The professionals documented interaction with healthcare and social functions, but very few reports to the Social Services were noted. For both groups, notes about social structures were almost absent. CONCLUSIONS Child Health Service professionals facing vulnerable children document parental health issues and interaction with healthcare, but they fail to document living conditions thereby making social structures invisible in the health records. The child perspective is insufficiently integrated in the documentation and serious child protection needs remain unmet, if professionals avoid reporting to Social Services.
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Affiliation(s)
- Marie Köhler
- Department of Clinical Sciences, Lund University, Kunskapscentrum barnhälsovård, Region Skåne, Ängelholmsgatan 1 c, 205 02, Malmö, Sweden
| | - Maria Rosvall
- Institute of Medicine, Gothenburg University, Gothenburg, Sweden
| | - Maria Emmelin
- Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö, Sweden
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Kling S, Vinnerljung B, Hjern A. Somatic assessments of 120 Swedish children taken into care reveal large unmet health and dental care needs. Acta Paediatr 2016; 105:416-20. [PMID: 26684221 DOI: 10.1111/apa.13304] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 11/23/2015] [Accepted: 12/07/2015] [Indexed: 11/29/2022]
Abstract
AIM For decades, non-Nordic countries have consistently reported high rates of somatic health problems among children placed in care by the authorities. This study examined the unmet health and dental care needs of Swedish children in foster and residential care. METHODS The health of 120 consecutive children aged 0-17 years, who had recently been placed in foster or residential care in one Swedish region, was assessed by an experienced paediatrician using patient records, their medical history and a physical examination. RESULTS Following the assessments, 51% of the subjects received at least one referral to a specialist or to primary care, either for a previously undetected medical condition or for a follow-up of a previously detected condition noted in their patient records. The study showed that 40% of the girls and 33% of boys were overweight and completed vaccination rates were only 86% for children up to the age of six and 68% for 7- to 17-year-olds. Half of the 7- to 17-year-olds had untreated dental decay. CONCLUSION Our study revealed a large unmet need for health and dental care interventions among children placed in foster care and residential care and a systematic strategy is required to address those needs.
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Affiliation(s)
| | - Bo Vinnerljung
- Department of Social Work; Stockholm University; Stockholm Sweden
| | - Anders Hjern
- Clinical Epidemiology; Department of Medicine; Karolinska Institutet and Centre for Health Equity Studies; Stockholm University/Karolinska Institutet; Stockholm Sweden
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